Changes to fees could affect Essex patients’ access to blood tests

Essex Mayor Ron McDermott is upset with the possible closure of the blood test lab at 169 Talbot Street south in Essex. McDermott hopes a large regional lab will take over or the town council can find some funding to keep the service going. (JASON KRYK/The Windsor Star)

Residents in the town of Essex might have to travel outside the community for blood tests after a change in the fee doctors can charge to have blood drawn is making it too expensive for a local family doctor and pharmacy to pay the technician.

Some people in town worry that losing the lab – which employs one technician (called a phlebotomist) to draw blood – could result in more hospital visits.

The dilemma also raises the bigger question of whether rural areas’ unique circumstances are being overlooked in changes to provincial health policy.

Since November the phlebotomy service at 169 Talbot St. S. in Essex has been operating with subsidies from the owner of the pharmacy and one of the family doctors who shares the building.

Before the fee change, family doctors could bill $5.10 to OHIP to send a patient for a diagnostic test, including to have blood drawn. This fee is known as the “Sole Procedure Premium” and contributes to the operating costs of doing the test, said David Jensen, a spokesman for the Ministry of Health.

For those doctors in the Town of Essex who referred their patients to this particular phlebotomy site, the fee they charged covered the cost of paying the phlebotomist to draw the blood and send the samples off-site to a large regional lab for analysis and reporting.

But the Ministry of Health changed the Sole Procedure Premium in May this year for doctors working in what are known as Family Health Networks or Family Health Organizations. Now, the fee is 77 cents.

Jensen explained that doctors in FHNs and FHOs already receive other payments from the province to provide a “basket of services” including ordering certain diagnostic tests, so the $5.10 was, in fact, a doubling up.

But community leaders in Essex argue that the doctors who relied on this phlebotomist can no longer afford to run the service since the wage can’t be generated by the lower OHIP fee alone.

Gregg Charlton, the owner of the pharmacy in the same building, estimated that roughly 400 people use the service – which is open five mornings per week – each month. Blood work is required for many medical conditions like diabetes, cholesterol, thyroid function and anemia, Charlton said, adding that he’s concerned losing the phlebotomy service could result in sicker patients and, as a result, more hospital visits.

In Essex, the options for phlebotomy services are fewer than in the city. For example, patients enrolled at the Essex nurse-practitioner clinic have access to a nurse there who can draw blood (the way the province funds the clinic allows it to offer the service, the director there explained), but the service is not available to walk-in patients.

The most viable option is to see whether a privately-run regional lab (such as Gamma Dynacare) is willing to take over the service, but the town’s mayor and the local MPP both expressed concerns that private lab operators might not leap at the opportunity to open up shop in Essex unless it makes business sense, and Essex is not a very big community.

Charlton said he expects to hear back from CML HealthCare, a private lab service with a site in Kingsville, about whether it is willing to take on operating a phlebotomy site in Essex.

Private labs are governed by a provincial law which allows them to bill OHIP directly for drawing blood and performing other services, but they are subject to billing limits.

While he declined to say how much he was contributing, Charlton said he can’t keep subsidizing the service for much longer. “I just don’t want to see the service interrupted,” he said.

Essex Mayor Ron McDermott said he is concerned some residents are going to have to drive out of town to get blood drawn at labs in Windsor or other parts of the county.

“We’re just going backwards,” McDermott said of the ministry’s decision to change the fee.

MPP Taras Natyshak (NDP – Essex) said older people and those who can’t travel 20 or 30 kilometres out of town to the nearest regional lab could face a real problem if the Essex site stops running. He said he’s tried to contact the Ministry of Health to see if Essex can be exempt from the fee change and keep the original fee structure, but he wasn’t able to get very far.

The Ministry of Health spokesman said that there are no exemptions to the fee change because the decision was made by the doctors to withdraw the service in response to the fee change.

“The ministry is committed to ensuring Ontarians have access to health care services in their communities and as close to home as possible,” Jensen said in an email. “On another front (not involving physician practices), we have been actively working with our community laboratory partners to improve our ways of identifying and responding to areas that would benefit from additional laboratory collection services. The ministry will continue to hold discussions with our partners to understand the needs and expectations of patients in affected communities.”

Dr. Haider Hasnain, the president of the Essex County Medical Society said that there has been some talk among rural physicians of going to their local town councils to see if they can get special funding to offer phlebotomy services so that people don’t have to travel outside their community to have vials taken.

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